New York Ambulance Cardiac Catheterization

Should your cardiac catheterization lab be open on weekends?

For the majority of cardiology professionals working in larger hospitals, doing on-call work out of hours is just a part of every day life. Whilst most people don’t like it, it does provide staff with extra pay and the possibility of additional time off, so therefore the positives often outweigh the negatives. Whilst we know patients that arrive as an emergency (for a primary PCI) benefit from immediate out of hours care by an on-call team, what about those stable high-risk and low-risk patients who have their procedures delayed until a more suitable in-hours time?

A recent study published in the Canadian Journal of Cardiology looked at an early versus delayed invasive intervention strategy for patients presenting on weekdays and weekends. The results showed that for patients experiencing non-ST-segment elevation acute coronary syndromes (NSTE-ACS), an early invasive strategy significantly reduced costs, even on weekends, because of resulting shorter length of hospital stays.

The lead investigator Andre Lamy, MD, MHSc, Population Health Research Institute, and Professor in the Department of Surgery and Department of Clinical Epidemiology, McMaster University stated, “Hospitals that currently tend to delay stable patients in favor of weekday catheterization instead of mobilizing the on-call team for an earlier invasive management of NSTE-ACS patients should consider the latter, as the savings from adhering to the timing of an early intervention approach would outweigh additional costs”.

The study was compiled by analysing data from 479 Canadian patients from the Timing of Intervention in Acute Coronary Syndromes (TIMACS) multinational trial. The early strategy group contained 238 patients, whilst the delayed strategy group contained 241 patients. By the end of the trial, those patients in the early strategy group saved CAN $2,938 per patient compared to those who underwent a delayed strategy, because they spent 2.3 less days in hospital. The majority of those savings came from the reduced length of hospital stay, especially in the ICU/CCU and ward units.

The TIMACS lead investigator Dr Shamir R. Mehta explained, “The results of our Canadian-led multinational trial shows that early intervention is a cost saving strategy for all patients with acute coronary syndromes. In higher risk patients, early intervention also appears to improve clinical outcomes.”

Dr Lamy added, “Given many high-risk NSTE-ACS patients receive delayed intervention due to weekend catheterization lab status, these findings support opening catheterization labs on weekends to facilitate the use of early invasive intervention.”


Author:

Tim Larner
CEO and Senior Cardiac Radiographer
Coronary Heart Publishing Ltd
Manchester
United Kingdom
 

Editors note:

Whilst the cost saving benefits appear sound for early intervention of patients with NSTE-ACS on weekends, the reality for actual cardiology departments could mean the savings are a lot less. With the increase in primary PCI procedures performed out-of-hours, many departments are stretched extremely thin the following day if the team were called in overnight or on weekends, due to mandatory rest periods. Therefore treating even more patients has the very high potential of having a very negative impact on departments and result in the loss of personnel.

Questions?

  1. What are your thoughts?
  2. Do you think your department could handle being open on weekends?
  3. What do you think the best strategies would be?

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